The 1999 Court of Appeal ruling in the case of A.D.& G. vs North West Lancashire Health Authority also had significant ramifications for Health Authorities (now PCTs) in terms of the funding of treatment of any kind relating to gender identity issues. This ruling recognised that gender reassignment is the appropriate medical response to “Gender Identity Disorder” and that it unlawful for Health Authorities (PCT’s) to operate anything that amounts to a blanket ban on funding in such cases.

In the wake of these significant legal landmarks, considerable social advances have taken place too. The stigma attaching to gender variance is being rapidly eliminated in British society, along with a great deal of the ignorance and disapproval. This sea change in official and public opinion is set to be strengthened by Government commitments to address remaining vulnerabilities of trans people in discrimination law, and promote greater knowledge and awareness through the forthcoming Public Sector Duty on Gender and through the promotion and enforcement roles of the new Commission for Equality and Human Rights.

With both of those significant changes in mind it is disappointing that attitudes towards trans people in medicine, and especially the National Health Service, have changed very little. Indeed, this failure to advance significantly can be seen to apply at every level:

The conceptualisation of gender variance, developed by medical practitioners and sexual theorists in the 1950’s and 1960’s, fundamentally reflects Western cultural beliefs of that time. The legal and social advances of recent years lead to medical thinking in this area being seen as increasingly anachronistic and reactionary. As this fossilised thinking underpins so much else, a part of our campaigning effort takes place with reformers at all levels and in other countries, challenging medical classification itself. It’s a serious matter to classify mere difference as a mental illness.

The last ten years have undoubtedly witnessed some change in medical ideas, though not yet as sweeping as to dislodge the “mental illness” label. The Harry Benjamin organisation is changing its name. Out goes the built-in pathology-based vision of “Gender Dysphoria” in the title. In its place the emphasis conveyed by the “World Professional Association for Transgender Health” (WPATH) signals a different and more client-centred emphasis - though no corresponding change yet in the protocols.

Closer to home, Britain’s Royal College of Psychiatrists has been working for two years to develop guidelines more tailored to the UK environment. Our place is at the centre of developments like this, where the struggle again involves the tension between the old and the new. Our challenge is to shift conservative medical attitudes sufficiently for services to begin to mirror social change and prevent the harm which present approaches can be seen to cause.

Anachronistic “standards of care” or guidelines lead in turn to a system of regimented Gender Identity Clinic (GIC) services that are perceived by many as controlling and even abusive

Commissioning restrictions that remove choice from service users create an unhealthy “take it or leave it” monopolistic attitude in many GICs. Attempts to write the new care guidelines in ways that serve to prevent diversity in service provision are another way of trying to cement the status quo. Our task involves advising people who feel harmed by the process, and drawing attention to the need for review and change.

All these factors then combine with financial constraints on the NHS, plus ordinary ignorance and prejudice, to create what is now becoming an increasingly problematic situation with the commissioning and funding of treatment for gender issues, and the non-availability of choice. An increasing part of our effort is therefore also directed towards this problem.

In order to have an effective strategy it’s necessary to grasp all these related dimensions of the problem and to campaign at all levels:

Through PFC-News and our regular analyses and papers we provide materials which explain the issues involved. Documents on this web site highlight the politics of dealing with medical professionals and academics, document the obstructions which people face, and provide the background resources to help others help us as well.

We are involved in working actively for change at all levels - from the question of medical classification to local funding. We work through the Parliamentary Forum on issues such as the adoption of guidelines for commissioners, and the need for licensing of hormones and hormone blockers for prescription in this area. We are a member of the CX Gender Identitiy Clinic Stakeholders committee, sadly this is currently suspended.

Trans people’s issues are not restricted to support and funding related to transition either:

We only have one transition in life, but all of us will experience many other needs for healthcare, preventative medicine and social care during our post-transition lives, just like everyone else.

The National Health Service is also Britain’s largest single employer. The health and social care field is also one of the biggest overall employment sectors, and many trans people want to be able pursue careers at every level. As in other sectors of employment this brings issues of employer preparedness and training. Our approach has also required us to demolish many barriers too - in access to medical and nursing training, Criminal Records checks and professional registration to cite just three.

Our overall strategy therefore demands that we work on many fronts at once. The interrelated nature of the issues requires that. It also requires us to come at problems from all angles — using complaint and legal process to force change by confrontation of the issues, and simultaneously working in partnership with politicians, civil servants and medical professionals to encourage changes in approach from the top.

How we campaign

In summary, our methods are to:

Collect and document evidence through the problems we see, and by encouraging people to tell their stories

Use this background to build awareness of the problems which real trans people experience

Develop from that awareness an agenda for change among decision makers

Ensure we are involved where those decisions are made, rather than simply being outside on the barricades. Some of the main areas where we work are :
- In the Department of Health, through the Equality and Human Rights Group
- On the Royal College of Psychiatrists’ Committee developing new guidelines
- In PCTs, developing local commissioning strategies

Feed the pressure for reform by encouraging people to complain and engage with quality processes

Work with our natural allies and as part of wider movements for healthcare reform

Who is involved

Stephen Whittle is is a former President of WPATH (the World Professionals Association for Transgender Health - formerly HBIGDA). As Professor of Equalities Law at Manchester Metropolitan University Stephen is also PFC’s expert in all matters concerning the legality of trans healthcare experience.

Other trans people, not directly involved in Press for Change, have very significant roles in the reform process. Persia West, for instance, produced a comprehensive report on behalf of Brighton’s Spectrum Group, for the former Brighton and Hove PCT, conveying widespread criticism of the Charing Cross Gender Identity Clinic, on which that PCT depended. She is now working with others to encourage the development of alternative service approaches in that area. Other trans people are similarly engaged with processes in other PCTs.

How people can help

The most important ways in which trans people and their friends / families can help is by

Complaining when services do not measure up to the standards now promised within other areas of healthcare, or when choices are restricted or funding is withheld. Don’t be a victim. Use the instructions below for guidance on the processes available.

Contributing evidence of the experiences you have when seeking help and support within the health service.

Lobbying at all levels to demand that problems be investigated and that change should be forthcoming. Get involved, like other citizens in the running of your Primary Care Trust (PCT). Learn how commissioning works and how to influence the system.